An International Classification of Function, Disability and Health (ICF)-based investigation of movement impairment in women with pelvic organ prolapse
Open accessAbstract
Background: There is little evidence on movement impairment of the abdominal and pelvic floor muscles (PFM) in women with pelvic organ prolapse (POP). Objectives: The aim of this study was to determine the movement impairments and interactions between the PFM and abdominal muscles in POP. Method: The PFM and abdominal muscles of 100 conveniently sampled South African women with POP were assessed by ultrasonography, electromyography (EMG), the PERFECT scale, Sahrmann scale and a Pressure Biofeedback Unit (PBU). A demographic questionnaire determined contextual factors (exercise and medical history) and Visual Faces Scale pain intensities. Data were analysed descriptively and with Spearman and Pearson correlation coefficients. Results: Participants (59 ± 9.31 years) were mostly unemployed (80%), physically inactive (85%), with comorbidities, heart or vascular disease, hypothyroidism and depression. The mean levator hiatus at rest (56.38 mm, standard deviation [SD] 9.95), thickness (5.1 mm, SD 1.41), amount of movement (4.28 mm, SD 6.84), strength (level 1.89, SD 1.13) and endurance (4.04 s, SD 3.32) of the PFM indicated dysfunction. Median values of zero were found for the Sahrmann scale (interquartile [IQ] range [0–1]) and PBU (IQ range [0–2]) and 10.95 µV for abdominal EMG (IQ range [7.9–17.8]). Pelvic floor muscle strength, endurance, movement and EMG activity correlation was fair ( r > 0.4, p < 0.001), as was PFM strength, endurance and abdominal muscle function ( r > 0.4, p < 0.05). Conclusion: Movement impairment of local and global stability and mobility functions of PFM and abdominal muscles was present, as well as correlations between these functions. Addressing these impairments may affect the identified contextual factors (socio-economic, psychological and lifestyle factors) and the possible activity limitations and participation restrictions in patients with POP. Further research is needed to investigate these interactions. Clinical implications: The findings suggest that assessment and management of patients with POP might need to be based on a comprehensive neuro-musculoskeletal assessment and a holistic approach. Standardised protocols for patients with pelvic floor dysfunction (PFD) should therefore be used with caution. Randomised controlled trials should investigate patient-specific and holistic intervention approaches.
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The construct validity, sensitivity, specificity, test-retest reliability, and inter- and intrarater reliability of the pelvic floor and abdominal measurement procedures were reported by Brandt and Janse van Vuuren.
“The construct validity, sensitivity, specificity, test-retest, and inter-and intrarater reliability of these procedures were reported in Brandt and Janse van Vuuren.”
From Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial (2022) · cites this paper as [27]
The Methods sections on pelvic floor and abdominal muscle measurement report validity or reproducibility for some procedures and intra- and inter-rater reliability for others (page numbers unavailable). They do not report sensitivity, specificity, or specifically construct validity for those procedures. The test–retest coefficient found in the Methods applies to a pain-rating scale, not the pelvic floor or abdominal measurements. (LLM, conf=0.88)
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Cites
Is pelvic organ prolapse a cause of pelvic or low back pain?
Heit, M. (2002) · Obstetrics & Gynecology · doi:10.1016/s0029-7844(01)01626-x · Cited by 57 · see citing works
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Research works printed but not linked: 27
- Auchincloss C. & McLean L., 2012, ‘ Does the presence of a vaginal probe alter pelvic floor muscle activation in young, continent women?’, Journal of Electromyography and Kinesiology 22, 1003– 1009. 10.1016/j.jelekin.2012.06.006 22892546 · DOI
- Brumitt J., Matheson J.W. & Meira E.P., 2013, ‘ Core stabilization exercise prescription, Part 1: Current concepts in assessment and intervention’, Sports Physical Therapy 5(6), 504– 509. 10.1177/1941738113502451 PMC3806181 24427424 · DOI
- Devreese A., Staes F., De Weerdt W., Feys H., Van Assche A., Penninckx F. et al, 2004, ‘ Clinical evaluation of pelvic floor muscle function in continent and incontinent women’, Neurourology and Urodynamics 23, 190– 197. 10.1002/nau.20018 15098213 · DOI
- Dietz H.P., 2004, ‘ Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects’, Ultrasound in Obstetrics and Gynecology 23, 80– 92. 10.1002/uog.939 14971006 · DOI
- Dietz H.P., Shek C. & Clarke B., 2005, ‘ Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound’, Ultrasound in Obstetrics and Gynecology 25, 580– 585. 10.1002/uog.1899 15883982 · DOI
- Grewar H., McLean L., 2008, ‘ The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence’, Manual Therapy 13, 375– 386. 10.1016/j.math.2008.01.003 18339574 · DOI
- Jensen G.M., Hack L.M., Nordstrom T., Gwyer J. & Mostrom E., 2017, ‘ National study of excellence and innovation in physical therapist education: Part 2 – A call to reform’, Physical Therapy 97(9), 875– 888. 10.1093/ptj/pzx062 28586468 · DOI
- Jull G., Moore A., Falla D., Lewis J., McCarthy C. & Sterling M., 2015, Grieve’s modern musculoskeletal physiotherapy, Elsevier, Edinburgh.
- Khan Z.A., Whittal C., Mansol S., Osborne L.A., Reed P. & Emery S., 2013, ‘ Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction’, Journal of Obstetrics and Gynaecology 33(7), 710 10.3109/01443615.2013.813913 24127961 · DOI
- Laycock J. & Jerwood D., 2001, ‘ Pelvic floor muscle assessment: The PERFECT scheme’, Physiotherapy 87(12), 631– 642. 10.1016/S0031-9406(05)61108-X · DOI
- Lima P.O.P., Oliveira R.R., Filho A.G.M., Raposo M.C.F., Costa L.O.P., Laurentino G.E.C., 2012, ‘ Concurrent validity of the pressure biofeedback unit and surface electromyography in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain’, Revista Brasileira de Fisioterapia 16(5), 389– 395. 10.1016/j.jbmt.2011.06.003 22832703 · DOI
- Maxwell M., Semple K., Wane S., Elders A., Duncan E., Abhyankar P. et al, 2017, ‘ PROPEL: Implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: A realist evaluation and outcomes study protocol’, BMC Health Services Research 17, 843 10.1186/s12913-017-2795-x 29273048 PMC5741940 · DOI
- Mills J.D., Taunton J.E. & Mills W.A., 2005, ‘ The effect of a 10-week training regimen on lumbo-pelvic stability and athletic performance in female athletes: A randomized-controlled trial’, Physical Therapy in Sport 6, 60– 66. 10.1016/j.ptsp.2005.02.006 · DOI
- Milsom I., 2016, ‘ Prediction and prevention of pelvic floor dysfunction’, Australian and New Zealand Continence Journal 22(4), 87.
- Olsen A.L., Smith V.J., Bergstrom J.O., Colling J.C., Clark A.L., 1997, ‘ Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence’, Obstetrics and Gynecology 89(4), 501– 506. 10.1016/S0029-7844(97)00058-6 9083302 · DOI · Paper page
- Park D-J. & Lee S-K., 2013, ‘ What is a suitable pressure for the abdominal drawing-in maneuver in the supine position using a pressure biofeedback unit?’, Journal of Physical Therapy Science 25, 527– 530. 10.1589/jpts.25.527 24259794 PMC3804982 · DOI
- Pool-Goudzwaard A., Van Dijke G.H., Van Gurp M., Mulder P., Snijders C. & Stoeckart R., 2004, ‘ Contribution of pelvic floor muscles to stiffness of the pelvic ring’, Clinical Biomechanics 19, 564– 571. 10.1016/j.clinbiomech.2004.02.008 15234479 · DOI
- Quartly E., Hallam T., Kilbreath S. & Refshauge K., 2010, ‘ Strength and endurance of the pelvic floor muscles in continent women: An observational study’, Physiotherapy 96, 311– 316. 10.1016/j.physio.2010.02.008 21056166 · DOI
- Sahrmann S.A., 2014, ‘ The human movement system: Our professional identity’, Physical Therapy 94, 1034– 1042. 10.2522/ptj.20130319 24627430 · DOI
- Sapsford R.R., 2004, ‘ Rehabilitation of pelvic floor muscles utilizing trunk stabilization’, Manual Therapy 9, 3– 12. 10.1016/S1356-689X(03)00131-0. 14723856 · DOI
- Sapsford R.R., Hodges P.W., Richardson C.A., Cooper D.H., Markwell S.J. & Jull G.A., 2001, ‘ Co-activation of the abdominal and pelvic floor muscles during voluntary exercises’, Neurourology and Urodynamics 20, 31– 42. 10.1002/1520-6777(2001)20:1<31::AID-NAU5>3.0.CO;2-P 11135380 · DOI
- Spitznagle T., Cabelka C., Clinton S., Abraham K. & Norton B., 2017, ‘ Diagnosis dialog for women’s health conditions: The process and proposed pelvic floor muscle diagnoses’, Section on Women’s Health, American Physical Therapy Association 41(3), 154– 162. 10.1097/JWH.0000000000000086 · DOI
- Stanton R., Reaburn P.R. & Humphries B., 2004, ‘ The effect of short-term Swiss ball training on core stability and running economy’, Journal of Strength and Conditioning Research 18(3), 522– 528. 15320664
- Thompson J.A., O`Sullivan P.B., Briffa K., Neumann P. & Court S., 2005, ‘ Assessment of pelvic floor movement using transabdominal and transperineal ultrasound’, International Urogynecology Journal 16, 285– 292. 10.1007/s00192-005-1308-3 15782286 · DOI
- Townsend M.K., Danforth K.N., Rosner B., Curhan G.C., Resnick M.N. & Grodstein F., 2008, ‘ Physical activity and incident urinary incontinence in middle-aged women’, Journal of Urology 179, 1012– 1016. 10.1016/j.juro.2007.10.058 18206951 PMC2712871 · DOI
- Wang Y-C., Hart D.L., Mioduski J.E., 2012, ‘ Characteristics of patients seeking outpatient rehabilitation for pelvic-floor dysfunction’, Physical Therapy 92(9), 1160– 1174. 10.2522/ptj.20110264 22539228 · DOI
- Zhu L., Lang J.H., Chen J. & Chen J. 2005, ‘ Morphologic study on levator ani muscle in patients with pelvic organ prolapse and stress urinary incontinence’, International Urogynecology Journal 16, 401– 404. 10.1007/s00192-004-1281-2 16007351 · DOI
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Brandt, C., & van Vuuren, E. C. J. (2022) · Physiotherapy Canada · doi:10.3138/ptc-2020-0053 · Cited by 4 · see citing works
Self-citation
- Authors
- Brandt, C., & van Vuuren, E. C. J.
- Affiliations
- University of the Witwatersrand (ZA)
- Corresponding author
- Brandt, Corlia
- ORCID
- Brandt, Corlia
- Venue
- South African Journal of Physiotherapy
- Publisher
- AOSIS
- Published
- 2019-02-14
- Volume
- 75
- Issue
- 1
- Pages
- 472-472
- ISSN
- 0379-6175 (ISSN-L)
- 2410-8219
- PMC
- PMC6407450
- OpenAlex
- W2913891189
- Cited by
- 11
- References
- 1
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2021: 5 · 2020: 2
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- South African Journal of Physiotherapy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Keywords
- pelvic organ prolapse, pelvic floor dysfunction, pelvic floor muscle strength, pelvic floor muscle endurance, abdominal muscle function, electromyography, motor impairment, ICF, levator hiatus, women's health, physical activity, socioeconomic factors, pain intensity
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